NHS CUMBRIA

Barrow-in-Furness Support for Future Services

Community Engagement Project

Report fromTHE CAMPAIGN COMPANY

June 2009

CONTENTS

1 Executive summary 3

2 Aims and objectives 4

3 Methodology 6

4 Findings 9

5 Conclusions 18

AppendicesAPPENDIX 1Topic guideAPPENDIX 2 Early draft Vision and Goals for testing

1 Executive Summary1.1 NHS Cumbria is keen to ensure that the future development of the

community health and social care system in Barrow-in-Furness is informed by the experience and expectations of people living and working there rather than simply the commissioners and providers of services. To that end, it commissioned The Campaign Company (TCC) to conduct a deliberative engagement process that would involve local people.

1.2 To achieve this, a series of visioning deliberative workshops were conducted with target groups of members of public, harder to reach groups and community stakeholders that aimed to:

identify what works well at the moment and what helps people to improve, restore or maintain their health and wellbeing

develop a vision of what an excellent community health and social care system would like like

focus on aspirations rather than deficits

1.3 Key conclusions and insights from the work include the following: Barrovians are aware that they currently do not have world class

health - they need to be inspired and motivated to take the necessary steps to overcome this

Everyone knows that unhealthy lifestyles can lead to poor health but the right tools / incentives to tackle this are missing

There is an understanding that good health is the responsibility of residents and health professionals in partnership.

People should be provided with the resources and skills to manage their own health

A seamless health and social care service is of paramount importance to everyone

Health advice will only be sought from professionals other than doctors and places other than hospitals when there are assurances around expertise and confidentiality

Having health professionals with excellent interpersonal skills is as important as having qualified and expert health professionals.

1.4 The following vision for health and social care in Barrow-in-Furness was developed through the process of deliberation:

As a resident of Barrow, I want to live an active and fulfilling life. I am proud of our town and particularly the friendly way we

care for each other. It's our really strong sense of community that makes us love Barrow. That is why all of us, working with the local health service, need to take responsibility for taking care of our physical and mental health and our general well-being. People in our town have built a strong reputation for

world class skills, whether in engineering, shipbuilding or the many other types of work we do. We therefore deserve a local

health service that is equally world- class.

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2 Aims and objectives

2.1 Since the NHS Plan 2000, there has also been a modernisation programme within the NHS which has at the heart of it the Derek Wanless vision of a ‘fully engaged citizen’ who is empowered to make informed choices and take more responsibility for their own health care. Lord Darzi’s Next Stage Review and World-Class Commissioning are the most recent of a succession of Government legislative measures, policies and guidance, signifying a cultural shift from top down to bottom up approaches to involving and actively engaging patients and members of the public. These and other drivers have made health agencies acutely aware of the need to take community engagement and empowerment seriously if they are to achieve the freedoms and flexibilities they themselves seek.

2.2 NHS Cumbria has an excellent record of providing high quality primary health services which local people appreciate and value. The Healthcare Commission recently noted that the PCT had made significant improvements in its use of resources and quality of services provided. While health outcomes against key national indicators are improving in the county, it is of concern to NHS Cumbria that Barrow- in-Furness is performing relatively less well in most of the key national health indicators than other areas as shown below.

Indicator Barrow County Average National AverageMale Life expectancy

76 years** 77.65 years**

Female life expectancy

80.94** 81.81**

Male all age all cause mortality

856 per 100,000* 756 per 100,000* 789 per 100,000*

Female all age all cause mortality

552 per 100,000* 512 per 100,000* 514 per 100,000*

Under 75 Circulatory disease

99 per 100,000* 83 per 100,000* 85 per 100,000*

Suicides 9.25 per 100,000* 11.21 per 100,000* 8.25 per 100,000*Accidents 23.9 per 100,000* 19.2 per 100,000* 15.9 per 100,000*Infant mortality rate 4.3 per 1000 live

births*4.6 per 1000 live

births*5.0 per 1000 live

births* *2004-2206 data** 2005-2007 data

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NHS CUMBRIA STRATEGIC PLAN 2008-2013Our vision is to improve the health and well being of all

people in Cumbria and help them to stay, active, independent and in control for as long as possible.

Given the demographic changes anticipated in Barrow there are likely to be increased health challenges, and fewer resources to tackle them.

2.3 A range of activities are already in place to improve health outcomes in Barrow-in-Furness, including those captured in:

Cumbria PCT Public Health Strategy Cumbria PCT Closer to Home North Barrow-in-Furness Health Improvement and Health Inequalities

Strategy Moving Care Closer to Home – Integrating health and social care

for adults in Cumbria. At the heart of all of these is a shared commitment to improving health outcomes and recognition of the need for a collaborative approach to build capacity to achieve the improvements needed in both services and infrastructure.

2.4 It is within this context that NHS Cumbria commissioned TCC to conduct a specific project to further inform the future development of both community health and social care services in Barrow in Furness. The approach underpinning this was to ensure that the development and realignment of services and infrastructure would be informed by the experiences and expectations of people living and working in Barrow in Furness.

2.5 Specific objectives to be achieved through this process also included the following:

Identify how the community health and social care system can be developed to better realise and harness the potential of individuals and communities in achieving improved health outcomes;

Provide key insights for those working within the community health and social care system;

Enable local people to be fully involved in the development of new ideas for services – and shape the ‘what, how and where’ of how they can be delivered.

2.6 This process was also used to test and further refine a vision and service expectations for Barrow healthcare that had been developed by the PCT.

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3 Methodology

3.1 In order to achieve the objectives, we conducted a series of visioning deliberative workshops with residents, hard-to-reach groups and community / third sector stakeholders within Barrow. Deliberative public engagement is a distinctive approach to involving people in decision-making. It is different from other forms of engagement in that it is about giving participants time to consider and discuss an issue in depth before they come to a considered view. It is also a process that by necessity capacity-builds participants to become knowledgeable in areas that they are not usually familiar with. It therefore engenders a greater sense of responsibility for and ownership of the decisions ultimately taken and empower participants for the future.

A The recruitment process3.2 We identified the following as the key target groups:

a representative group of members of the public who have recent experience of community health or social care services and who have not previously been engaged in consultations such as this;

a representative group drawn from the disadvantaged and hard to reach groups within the Barrow in Furness community, who have recent experience of community health or social care services and who have not previously been engaged in activities such as this.

a stakeholder group from local community health and social care services in the public and third sector, focussing particularly on front line staff and where appropriate, volunteers from the third sector.

3.3 We used a structured approach to reach the target groups identified and recruit representative samples from these. The data from which public participants were recruited was sourced to be representative of Barrow population in terms of demographic and socio-economic criteria. We worked closely with Cumbria CVS to recruit members for the hard-to-reach groups. Cumbria CVS and NHS Cumbria also facilitated the process of recruiting stakeholders.

3.4 As a result of our activity we recruited 30 participants from the three target groups as follows.

PublicFemale Teaching Assistant – 36 yrs oldFemale Administrator (Dept Work and Pensions) – 50+?Male 6th Form College student/ web designer – 18Female Secretary BAE Systems – 28Female Foster Carer – 60+?Female on social benefit with children – 30?Young female – teensMale retired teacher – 56

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Male engineer – 40+Male Electronics Engineer – 40+Male software Engineer – 30+Female retired nurse/ carer – 44

StakeholdersFemale – volunteer, Cumbria link 50+Female – Advocate BME community 30+Male – Barrow Councillor/ Development worker 40+Female – Barrow Multi Cultural Society 40+Male – Captain of Salvation Army 40+Male – Methodist minister 60+Female – Chief officer Barrow CVSFemale – Cancer patient/ member of Barrow Cancer Support 40+Female – Founder of Barrow Cancer Support 70+Male – Furness Carers 30+Female – Secretary of Barrow Disability Association 70+

'Hard to reach' groupFemale traveller age 20+, Cumbria Multi Cultural SocietyWife/ carer aged 70+ of advanced Alzheimers sufferer 2 males from Furness Homeless Support2 females from Project John Male from Carr Gomm

B The deliberative process 3.5 The activity we conducted as part of the deliberative process is

summarised below:

Activity PurposePre-consultation survey

Gauge participants knowledge and understanding of community health and social care in Barrow

Capture information that could be used to stimulate discussion at the deliberative workshops.

“Health in Barrow” deliberative workshops (3 separate workshops for each target group)

To set context for visioning process.

Familiarise participants with health profile and issues in Barrow

Gauge what participants experiences of health and social care services are

Test NHS Cumbrian's early vision and service expectations of health and social care for Barrow

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Activity Purpose Enable picture of current service

provision to be developed for testing at subsequent workshop

“Current services” combined deliberative workshop

Test scenarios for current service provision, covering acute, primary and mental health services.

“Future services” combined deliberative workshop

Test scenarios regarding service expectations in future

The key tools used to stimulate discussion were the draft vision and service expectations drawn up by NHS Cumbria and through scenario-testing1. These and the topic guides used at the events are available in the appendices.

1 A visioning technique that allows participants to develop an understanding of an unknown situation rather than trying to predict it.

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4 Findings

4.1 OverviewThe insight gathered from each of the groups have been consolidated to produce a final vision and underpinning goals. The findings are grouped in the following categories: where we are at a vision for Barrow health and social care services the shape of future services

4.2 Where we are atThe following summarises the conclusions from each of the first series of workshops.

a) Preventative health careThere is a long way to go in terms of winning hearts and mind to the importance of health promotion. The view is that (for example) :

“Everyone recognises , that eating too much leads to obesity and is not good for you so why waste money telling people what

they already know”.

This is underpinned by a belief that lifestyle changes are for the individual not for the state to enforce. People don’t make the link that spending money now on advertising campaigns, will save so much money down the line. There is also a feeling of scepticism about conflicting messages:

‘what’s good for you one week , is next week proved wrong’

Whilst lack of money and economic factors can impact on healthy living, ‘self worth’ was perceived to be a much more important factor. Whilst comments were made such as ‘it’s easier to buy junk food and have a drink and smoke in the house’ and ‘biscuits are a lot cheaper than grapes’ all agreed that in the end it is more about valuing yourself and taking responsibility.

There was a very strong feeling that families as a whole (ie adults and children) should be educated about healthy eating whatever their social situation – and that steps should be taken to ensure that schools, consumer outlets and workplaces were equipped to support them in this.

People are scared of health problems that they can’t control particularly mental health problems including Parkinsons disease and Alzheimers plus emotional problems including stress in the

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workplace. Mental health was high on the agenda of all three focus groups.

These latter two examples just re-emphasised a continuing theme of a partnership approach needed

b) Service expectationsIn terms of what people want and need from GPs and health professionals, there is a huge emphasis on interpersonal/ strong communication skills rather than medical skills (which are taken for granted).

People like to feel that the GP can ‘get down to their level’, is ‘friendly’ and ‘approachable’, ‘make you feel they are helping me’, have a ‘genuine interest and give clarity’, are a ‘good listener’.

Whilst people are prepared to seek advice from pharmacists and other service providers, rather than see their GP or go to A&E in the first instance, they need re-assuring that they are getting professional advice rather than “advice from a 16 year old with no experience/ knowledge.”

A need for 'privacy’ was also mentioned as being important in this situation – along with the ‘personal touch’.

The desire for a seamless service is of paramount importance. This relates to the way GPs and other service providers communicate, but also about communication within services eg hospitals themselves.

c) Key message carriersIn terms of assessing the quality of health and social care services, it was identified that people place much more importance on word of mouth from family, friends and peers than advice given by non-clinical experts.

4.3 A vision for BarrowThe following feedback from the testing of the early vision helped shape its refinement:

People in Barrow have a very strong sense of identity, they are 'Barrovians'who take pride in their town and take pride in their insularity-even its negative manifestations. Unfavourable comparison with other Cumbrians is not resonant. They embrace the concept of ‘closer to home objectives’ because they do not want to travel outside Barrow for treatment.

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Barrovians acknowledge that they have second class health but they don’t constantly need to be reminded of this. A more aspirational and empowering approach was advocated by all.

There is a scepticism about 'big' goals that are not 'smart'- there is need to be clear about how objectives and who has responsibility for achieving them.

This insight plus an iterative process enabled the following vision, service expectations and goals to be developed and agreed by the end of the process.

The vision and goals are written as a series of statements representing public expectations of the future level of services (based on initial work previously undertaken by the PCT)

VISIONAs a resident of Barrow, I want to live an active and fulfilling life. I am proud of our town and particularly the friendly way we care

for each other. It's our really strong sense of community that makes us love Barrow. That is why all of us, working with the

local health service, need to take responsibility for taking care of our physical and mental health and our general well-being.

People in our town have built a strong reputation for world class skills, whether in engineering, shipbuilding or the many other

types of work we do. We therefore deserve a local health service that is equally world- class.

SERVICE EXPECTATIONS AND REALISATION1. I would expect to live longer if, from the earliest

possible age, I am equipped with the skills and knowledge to enjoy good physical and mental health and to avoid injury

2. If I need support to deal with an illness or injury, I would expect it to fit around the life I lead

3. I will usually be able to access world-class health and social care services quickly and easily in my local community

4. I want to have the chance to express my view regularly about the development of local health and social care services

5. I will expect service providers to work closely together to provide a friendly, seamless and well informed service

6. I expect services that respond well to my needs through having a real choice about the ones I use.

The goals also include the elements of the framework that comprise the delivery of a health and social care system.

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GoalsServices I expect services that are relevant to my individual

needs and, where appropriate, provide me with choices over how I receive them. The services provided will be available when I need to use them to give me control as to how my care is delivered. These services should be provided as close to home as possible.

Transport

Where I have to travel for specialist services, I would expect adequate and affordable transport services to make care accessible, both for myself and for any other family members who may need to be with me. I expect providers of transport and health and social care services to work in partnership to share information and ensure alignment of services.

Care journey

I expect health and social care service providers to work together in order to provide me with a service that joins up and is seamless. This would mean that I am not shuffled from department to department or between organisations for my health and social care needs. Departmental or organisational boundaries should not cause me any unnecessary confusion.

Staff I have the right to expect all the staff I deal with in health and social care to be friendly, informative and highly skilled. I rely on them to understand my problems and needs and provide a quick and efficient service. Many of the services will be provided by the appropriate staff in local community-based settings.

Buildings

I have the right to expect health and social care buildings to be clean, accessible and provide a modern setting for the delivery of services. They should be welcoming and designed to ensure ease of access for people with disabilities.

Technology

I expect all the contact I have with health and social care to be quick, efficient and well-managed. Information about me should be confidential, safe and secure and found quickly and easily. I expect services to have an efficient take-up of well-tested and safe new technologies, particularly with regard to disease prevention.

The elements in each statement in bold highlight the features within each that are most important to participants.

4.4 The shape of future servicesTo enable participants to visualise how the vision and underpinning goals would work in practice, we developed and tested scenarios to facilitate the process. The final testing of the scenarios also acted as a

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final quality check to ensure the final vision that had been developed was correct.

These are the scenarios that encapsulate patient experience and service expectations in a future Barrow where the redefined vision and goals have been realised. These scenarios were developed using insight and feedback from the participants at the beginning of the deliberative process coupled with direction from clinicians as to feasibility of some of the suggestions. Feedback from the final testing as to missing elements / refinements that would be needed in the “ideal service” are included

Scenario Additions / challenges for delivering this

Experiencing a visit to the dentistIn the past my family had never managed to get on the list of an NHS dentist in Barrow – it was so difficult to find one and too expensive to go privately. Recently I suddenly developed really bad toothache and Mum called to try and find a local dentist. The lady she spoke too was really helpful and gave us details of a dentist we could go to. She also gave us advice about pain relief. We managed to get into see the dentist almost straight away which relieved Mum’s anxiety. When we got to the dentist’s surgery, it felt really welcoming – there were toys to play with while I waited. The dentist was very friendly and spent time examining me – he didn’t just whip the tooth out. He could see that there was going to be a problem with overcrowding in my mouth and arranged for orthodontic treatment. While I was there he asked the dental nurse to talk to me about oral hygiene and how to look after my teeth. They made it fun and I didn’t mind going back on future visits.

A truly seamless service would have other health professionals eg health visitors, school nurses, etc should be equipped to make referrals too.

Dealing with AlcoholIn my late teens – I went out on a hen night in Barrow, mixed my drinks and downed loads of cocktails. At the end of the night I collapsed on the pavement outside a club and I couldn’t get up. Apparently my friends were in a bad way also and they couldn’t help me. I didn’t end up going to Furness General in an ambulance as used to be the case. I was taken to an emergency care tent which had been set up at the end of the main street (it’s always there on a Saturday night). The paramedic on site wrapped me up in a warm blanket and stayed with me until I stopped being sick. She phoned one of my friends and arranged for her to come and pick me up. The paramedic wasn’t judgemental and didn’t give me a hard time – but she did tell my friend that I needed to know about the dangers of binge drinking and the associated risks such as pregnancy, VD , sexual abuse and injury. She was given him some information to pass on to me including a contact number I could ring for advice. She was also given a Chlamydia kit to

In terms of a holistic service, there should be after-care factored in. A follow-up call from someone within the health service to ensure the messages delivered on the night to the 'friend' where actually received and understood by the 'patient' would have a

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Scenario Additions / challenges for delivering this

pass on to me – just in case I’d had unprotected sex. After this episode I was very embarrassed and decided that I needed to take responsibility. This is the last time I fell down drunk in the street – I no longer mix my drinks or take part in stupid drinking games. I still drink and have a good time but I’m in control.

better effect than simply giving leaflets and chlamydia kit to the friend.

Coping with StressIn my mid 30’s, following the suicide of a good friend and being laid off work, I suddenly started finding life difficult to cope with. I thought this was just a phase but I found it increasingly difficult to get out of bed, felt constantly tearful and started to withdraw from everyone around me. I knew that if I went to my GP he would be supportive – as we’ve got a good relationship but it was still difficult making an appointment to seek help. I phoned the surgery mid-morning and spoke to the receptionist, who was friendly and accommodating. I was given a choice of appointments and was able to make one at the very end of the day which was handy as I have to look after the kids during the day. When I saw the GP, he was supportive and empathic. I felt he really got down to my level and he didn’t tell me to pull myself together – which was a real relief. He asked me lots of questions and really explored what was happening in my life before he prescribed any treatment. I told him I didn’t want to take anti-depressants. After considering my circumstances he suggested I go for counselling with the Primary Care Mental Health Team (linked to Surestart) to help me cope with stress and also learn cognitive skills to help me challenge my thought processes. He said I could either contact them directly myself and have a chat with them over the phone or he could make me an appointment with a counsellor there and then. I was so pleased he didn’t just prescribe medication. He gave me some web addresses for self help groups and also told me about the ‘Getting Back to Work Programme’ being piloted by the job centre – which was really handy as it gave me a bit of hope about getting back into work. He said he wanted me to come back to see him in a few weeks to review my situation – I was even able to make an appointment on a Saturday morning which was great, as it gave me flexibility.

There should be others within a GP practice or linked to a GP practice that are equipped to take on this type of role and to advocate this type of solution and approach.

Supporting those with CancerMy granddaughter developed leukaemia. It was a terrible shock for the family as we are all very close. We found out about her condition when we went to a joint specialist clinic in Barrow. She was diagnosed by the local paediatrician and a visiting super specialist in one of our new child friendly community clinics which are closer to home. In the past she would have had to go to the Children’s hospital in Manchester which was a nightmare, due to the cost of travelling and having to stay over there. However, the facilities in Barrow enabled her to be treated nearer home and this meant my daughter could see her on a

A quality service and accessibility for family and friends are the key aspects of cancer care that mean most to participants. Maybe a future development

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Scenario Additions / challenges for delivering this

daily basis without neglecting her other children. It also meant I could visit her regularly. The standard of care she received was world class and she has been in remission for a number of years. A multidisciplinary team worked together to get her better and were involved in the ongoing management of her condition. They kept us informed about her progress. We never felt that we were asking silly questions – as they explained things to us in a way we understood. After she recovered from cancer we all decided that we needed to eat more healthily and take more exercise - it was a big wake up call. Her mum now plans healthy meals and at weekends we all enjoy going cycling as a family. We have had lots of support from staff at Surestart about healthy living.

could be a “hospice at home” service.

Visiting A&E I have osteoporosis and in my late 60’s I fell and broke my arm. My neighbour took me to Furness General. On entering A&E I noticed that it had been modernised and was very clean. It was also warm and inviting, not draughty like it used to be. The new reception area ensured confidentiality (not like in the past where everyone could hear your business) and the receptionist was really kind and helpful. They instantly accessed my electronic medical records, checked my details and also asked about the drugs I was currently taking. As I waited to be seen in a comfortable chair, I noticed there were some nice pictures on the walls – done by local school children and bean bags for children to sit on. I was initially seen quite quickly because I was in a lot of pain – the Primary Care Assessment Team located within A&E made the initial assessment and provided me with pain killers, they took into account other drugs I was taking and gave me something which relieved the pain straight away. When I saw the doctor he was friendly and non-judgemental – he didn’t assume that because it was a Saturday night, I had fallen because I had been drinking! When he sent me for an X-ray the signs were easily visible and easy to follow. I noticed the new wheelchairs went forward rather than backwards – so it was easier for my neighbour to take me down. Although it was a Saturday night, I didn’t have to wait too long – I noticed there weren’t as many drunks in as there used to be. Following the x-ray I had my arm put in plaster – the technician carefully explained what he was doing and how long I would need to keep it on. When I went back to A&E a member of the Assessment Team took responsibility for discharging me. He asked me a lot of questions – things like how are you getting home? Is there someone to look after you at home? He spoke to me directly rather than to my neighbour who was younger than me. He also reassured me that my electronic medical records would be transferred to my GP and Social Services so that they could ensure I got the support I needed. During the following week the district nurse called to check on my progress. I was impressed

Modernisation of Furness General Hospital also needs to take into account parking requirements and access by public transport.

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Scenario Additions / challenges for delivering this

that the hospital had contacted my GP to inform her about my situation.Living with AlzheimersTwo years ago at the age of 76 my husband was diagnosed with Alzheimers (I was 74) – it was a devastating blow. We’d enjoyed many happy years together and then I started to notice that he was becoming very forgetful and that his personality was changing. I was exhausted by this point and really afraid life was going to carry on like this or get worse. I made an appointment to talk to the GP about this and before I went in to see him I mentioned to the receptionist that I felt stupid about raising it. She reassured me that it was okay – and that I was doing the right thing. The GP was also very understanding and really listened to me. I was scared they would just take my husband away – move him out of Barrow. This had happened to a friend of mine in the past – they moved him out of the local hospital and sent him elsewhere without consulting her. She was devastated. I arranged to bring my husband into see the GP and at this point, blood tests were taken and a mini mental state examination done. He was then referred to the local memory clinic – a one stop service involving further assessments and tests. It was confirmed here that my husband was in the early stages of Alzheimers and a treatment plan was established plus a care plan developed with social services. I was also given information about the Alzheimers Society and the phone number for Age Concern – all very helpful. On the way out I called at the pharmacy to collect the new drugs prescribed for my husband. I had been immediately re-assured that he wouldn’t be going away and at least for the short term he could stay at home with me – supported by a team of carers. This has worked well, as we both get the support we need from social services and the NHS. I get time off to visit my daughter and my husband goes into respite care from time to time to give me a break. I know he will probably have to go into a home that specialises in care for Alzheimers sufferers but I know it will be close to home, so that I can visit him. This will save me having to travel a long way to see him – it would be difficult for me at my age if I had to travel to other parts of Cumbria and also I worry about the cost. I feel that I am being given time to prepare for the future and most importantly feel that I am part of decision making process. Recently my husband fell and hit his head and I had to take him to A&E. On arrival, they immediately found my husband’s details and put us in a private bay to keep him calm. The wound was quickly covered by nursing staff. The doctor was sensitive in the way he spoke to my husband. He recognised that my husband didn’t understand and was anxious – and allowed me to stay with him at all times.

The key improvement would be ensuring a seamless sharing of data between all the different health providers.

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5 Conclusions

This deliberative process succeeded in delivering the following: the visioning of what an excellent community health and social

care system would like like from the perspective of people living and working in Barrow-in-Furness

an approach that focused on the resources and aspirations of individuals, communities and providers of services rather than on the deficits

a journey of decision-making that leaves NHS Cumbria with an empowered group of people with the capacity for future involvement.

The views of one participant summarises the consensus feedback from the group:

“I didn't know what to expect when I first came. I nearly didn't come because I don't have any qualifications so I thought I wouldn't be able to take part properly. But the person on the phone reassured me and she was right. I've got lots of views and experiences of my health and that of my friends and family so I was really able to take part. In that last session, I really understood and felt that story about depression and mental health services. My doctor wouldn't help me when I lost my job and had to live on the streets so that story is how I want it to be in the future. I'm really happy that the NHS is doing this work in Barrow and wants to make Barrow a better place for its people. If there's any more that I can do to help it then let me know. I'll come back running!”

Mark, 23, Barrow-in-Furness

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APPENDIX 1

'SUPPORT FOR FUTURE SERVICES' TOPIC GUIDE (Events 1)Deliberative Discussion Groups for NHS Cumbria

Background briefing note This topic guide has been developed to address the issues identified by NHS Cumbria as part of the “Support for Future services” project which aims to improve health outcomes for all in Barrow-in-Furness. The research outcomes identified are:

Identify how the community health and social care system can be developed to better realise and harness the potential of individuals and communities in achieving improved health outcomes;

Provide key insights for those working within the community health and social care system;

Enable local people to be fully involved in the development of new ideas for services – and shape the ‘what, how and where’ of how they can be delivered.

The topic guide has been designed to test and develop these issues with three key groups: health stakeholders, members of the public and harder-to-reach groups. The methodology to elicit the information is through a visioning process that allows the participants to examine their current experiences of health in Barrow to their aspirations of what health and social care in Barrow should be like in 2013.

Following these initial discussion groups, all participants will reconvene to jointly develop a consolidated vision for health and social care in Barrow by 2013.

Structure and timings

A Facilitator's introduction 10 minsB Group introductions (inc ice-breaker) 10 minsC Health in Barrow now – your experiences 20 minsD Health in Barrow now – the wider context 20 mins

Break 10 minsE Health in Barrow in 2013 – the vision and goals 45 minsF Health in Barrow in 2013 – your gold standard 15 minsG Next steps and close 5 mins

Proposed timings @ 2 hours 15 minutes

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DRAFT TOPIC GUIDE

NB All comments in italics below are explanatory notes and not questions to participants.

A FACILITATOR'S INTRODUCTION1. Introduce self and role2. Explain overarching objectives of project and outcomes we want from

the discussion groups3. (Where applicable) NHS Cumbria link to do welcome and project

outcomes – for public/hard to reach make sure the role of the PCT is explained.

4. Establish ground-rules for the groups

B GROUP INTRODUCTIONS Name? How long have you lived in Barrow? (public/hard-to-reach groups) How long have you worked in Barrow? (stakeholders) What do you like best about Barrow?

C HEALTH IN BARROW NOW – Your experiences[Exploratory questions to examine current experiences and support needs – use feedback from pre-event survey to stimulate discussion. Also tests primary vs secondary care experiences; touchstones; message carriers]

When was the last time you / member of your family went to a GP / dentist / community nurse / other community based service ie what is known as primary care services?

What was it? What was the experience like? [Prompt re: standard of care and quality of staff]

When was the last time you/your family used hospital services? What for? What was the experience like? [Prompt re: standard of care

and quality of staff]

As a patient / user of NHS and social care services, which of these is most important to you? Why? [Testing national touchstones; get group to agree top 3]

Circulate flashcard with priorities

PATIENTS NEEDSTo be more involved in decisions made by the NHSTo be receiving better customer care and an improved patient experience

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PATIENTS NEEDSTo be receiving higher quality clinical careTo be living a healthier lifestyleTo have a better opportunity to live a longer and healthier lifeTo be receiving more personalised careTo be receiving more integrated seamless care, when I need to get help from more than one organisationTo be able to receive more of my care closer to my homeTo be receiving the nest technologies as part of my careMy NHS to be maintaining a healthy financial position

What do you understand by being healthy and well? What is the most serious health threat that you worry about for

yourself? For members of your family What action – if any – are you taking to stop these things from

happening? [Prompt for lifestyle changes eg reduction in smoking, alcohol intake, dietary adjustments etc)

What would help (you/ your family) change your lifestyle (assuming they did perceive some health threats

Who would you trust to give you proper guidance / advice if you had a health problem? [Prompt for message carriers eg GP, nurse, family, friend, pharmacist, etc]

D HEALTH IN BARROW NOW – the wider context[Context setting of current health issues and priorities and testing PCT strategy; context setting for Support for Future Services]

County-wide contextModerator circulates worksheet and talks through:

2. PCT vision3. Outcomes – with particular resonance for Barrow4. Closer to Home objectives

(all from Geoff Joliffe's slides)

5. So to summarise, this gives a brief overview of where NHS Cumbria is at today and what the key health issues are across the county and in Barrow. Our Closer to Home objectives set out where we think we should focus our efforts to improve the healthcare of Cumbria and Barrow's population in the future. As a resident / worker / patient in Barrow do you think these objectives are right? Is there anything missing? Which is most important for you? Why? The Barrow context

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NHS Cumbria has already started developing a plan specific to Barrow's needs which we would welcome your views on.

Moderator circulates and talks through factsheets on:2. 'Barrow-in-Furness' at a glance3. Barrow Health Improvement plan priorities4. Examples of achievements to date

(All from Report of Director of Public Health and his presentation)

5. So to summarise this gives an overview of the state of health in Barrow. Where you aware of the issues that exist here? Is this your experience?

6. Have any of you heard of the achievement examples? Which ones? What do you think of them?

After the break, we will be focusing on the plans that NHS Cumbria has for achieving one of these priorities – getting the best health and social care system to meet Barrow's needs by 2013. This plan is called “Support for Future” services.

BREAK (10 minutes)

E HEALTH IN BARROW IN 2013 – THE VISION AND GOALS[Testing the Support for Future services vision and strategy]

NHS Cumbria has a vision of developing stronger primary care services (ie Gps, dentists, community-based health care) in Barrow by 2013 to help tackle some of the issues we've identified. Some work has already been done to develop this. At the heart of it is putting the service user at the centre of all that health and social care in Barrow do. The purpose of this session is to get your views on what's been done so far to make sure we're on the right track.

Moderator circulates and introduces through “Vision and Underpinning Goals” factsheet . Discussion in two parts: around vision and around the goals.

PART 1: Vision and how it will be realisedStimulate discussion to test for each strand:

people's understanding – is it clear? Is there a common understanding?

Is it comprehensive – especially in light of issues raised earlier? What if anything is missing?

Definitions and expectations eg world class health care, what is 'responsive', how much 'self-management' will people actually do, etc

Which of the 'realisations' is most important? Why?

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PART 2: Underpinning goalsStimulate discussion to test for each goal (ie estates, workforce, technology, integrated working, services):

people's understanding – is it clear? Is it comprehensive – especially in light of issues raised earlier?

What if anything is missing? What needs to be emphasised? Definitions and expectations clear? Eg what do they mean by

modern, clean and accessible (estates); highly skilled, friendly and informative (workforce), etc.

Which of the goals is most important? Why?

F YOUR VISION – A GOLD STANDARD FOR A SERVICE IN 2013[Initial development of a service standards – draw on discussions]

You and people in Barrow deserve the best. This vision will give you the best primary care services you deserve. Drawing on what we've said so far what are the five things that you would expect from a world class health care service?

G NEXT STEPS AND CLOSE Round-up Next steps – event 2 which will focus on collaborative work with other

stakeholder groups to determine “how to get there” Any questions Thanks

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APPENDIX 2 DRAFT VISION AND GOALS

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ESTATES

WORKFORCE

TECHNOLOGY

INTEGRATED WORKING

SERVICES

As a service user, I expect buildings in which services are provided to be modern, clean and accessible. They should be designed to ensure ease of access for disabled people.

As a service user, I expect staff I deal with in health and social care to be highly skilled, friendly and informative. I rely on them to understand my problems and needs and provide a quick and efficient service. Many of the services will be nurse-led and in community based settings.

As a service user, I expect each and every piece of contact I have with health and social care to be quick, efficient and well managed. I expect any information about me to be found quickly and easily. I expect services to have a high and efficient take up of new technologies, particularly with regards to disease prevention.

As a service user, I expect service providers to work together in order to provide me with a service that is seamless, meaning that I am not shuffled from Department to Department. Departmental boundaries do not cause me unnecessary confusion.

As a service user, I expect services that are appropriate and relevant to my individual needs and available when I need to use them. The services provided will enable me to gain real ownership of my care and will be fully responsive to my health needs. These services should be provided as close to home as possible.

How will this proposed vision be realised?• I will achieve longevity of life through developing, from an early age, the skills and knowledge to identify and reduce risks of serious illness or injury• In the event of requiring support to deal with an illness or injury, I will manage this support around my personal circumstances• Access to world-class health and care services will be quick and easy, and ideally found in my local community• By being fully involved in the development of health and care services, I know that service providers will work closely together to provide a seamless and well informed service. •I know that the service will be highly responsive to my needs and that I will have real choice about the services I use.

As a resident of Barrow, I will live an active and fulfilling life for as long as, if not longer, than my fellow Cumbrians